universal health coverage

Sarah Ruteri*, aged 14 months, is a survivor. A few months ago, I saw her admitted to the pediatric ward of Lodwar hospital in northern Kenya’s drought-affected Turkana district. Suffering from severe pneumonia, Sarah was gasping for breath – and fighting for her life. Her tiny ribcage was convulsed by a losing struggle to get air into her lungs. Doctors told her mother to expect the worst. But with a combination of oxygen therapy and intravenous antibiotics, Sarah pulled through.

At the Universal Health Coverage (UHC) Annual Financing Forum in Washington, DC, USA, on April 14–15, 2016, governments and development partners will debate how to raise and organize public and private resources needed for low-income and lower- middle-income countries to assure affordable, quality health care to all of their people by 2030.

It’s that time of year again, when we observe a day dedicated to the most ambitious health goal of all: universal health coverage, or UHC. On UHC Day (Dec. 12) we commemorate the date in 2012 when the United Nations unanimously endorsed a resolution urging governments to ensure that all people can access health care without financial hardship.

The launch of the Sustainable Development Goals (SDGs) at the recent U.N. General Assembly meetings brought especially welcome news: The future we want now officially includes universal health coverage (UHC), as defined under SDG 3, target 8. We also heard, the same week, from a group of economists from 44 countries, who publicly stated that “UHC makes economic sense.” It seems the tide has turned toward making essential health care available to all who need it, without creating financial hardship.

Somehow, everyone in the universal health coverage (UHC) universe seems to assume that the future of health financing will be built on centralized financing institutions fed by a mix of general tax revenue, payroll taxes and other contributions. This large pot of money, so the assumption goes, is administered by bureaucrats sitting in big buildings in national or provincial capitals. They contract with providers and pay them through capitation, diagnosis-related groups, fee for service, and reimburse retailers (pharmacists) for medicines that the patient takes home.

Maya is waiting for the physician to call her name. Her three children play in the waiting room, making happy noises, but she is worried about her health. The physician confirms her worst fears: it turns out that she has cervical cancer. Now what? A social worker tries to comfort her, saying that the medical staff will do their best to get her treated soon so that she can keep on working to sustain her family.

Last Friday, I had the privilege of attending the launch of a new global report that provides the clearest picture to date of countries’ progress moving toward universal health coverage (UHC). UHC is critical for building resilient health systems, which protect communities and strengthen societies in times of crisis and calm alike.